Department of Health & Family Welfare informed that the exclusive Cancer Hospitals / Units under CGHS in Hyderabad. This order contains Reimbursement details, Entitlement of ward details, Accommodation charges, Local purchase of medicines, Cost of Implants, Stents, Grafts and Surgical procedures etc.
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108
No: REC-1/2008/JD (Gr)/CGHS
Date: May 6, 2011
OFFICE MEMORANDUM
Subject: Fresh empanelment of Exclusive Cancer Hospitals / Units under CGHS, Hyderabad.
The undersigned is directed to state that CGHS had initiated action for fresh empanelment of Exclusive Private Cancer Hospitals / Units under CGHS vide Office Memorandum of even number dated the 28th January 2011 and on the basis of the applications received in response to the OM dated 28th January 2011, a list of Exclusive Private Cancer Hospitals / Units which have qualified for empanelment under CGHS Hyderabad is annexed.
2. In order that CGHS beneficiaries get treatment from well maintained and run hospitals, it has been decided to offer the rates of reimbursements for Cancer treatment, as per details given below:
2.1 Rates of Tata Memorial Hospital, Mumbai (2009), as mentioned under ‘B’ category for Cancer surgical procedures are treated as CGHS rates for treatment in Semi private ward with 10% decrease for GI. Ward and 15% enhancement for Private ward entitled patients.
2.2 The categorization of surgeries shall be same as per the categorization of TMH.
2.3 The duration of treatment for different categories of Surgery will be as follows:
Category —I -----------------1-2 days
Category II ------------------ 3-5 days
(7-10 days in respect of operations involving Abdominal / thoracic cavity)
Category III, IV & V -------- 14 days
2.4 The Super-specialty rates of CGHS Delhi for Cancer Radio-therapy shall be applicable as CGHS rates for Cancer Radiotherapy.
2.5. Chemotherapy medicines shall be procured from CGHS wherever feasible and as per available brand. In case, medicines are supplied by hospital, they shall provide on credit to pensioners and shall offer a discount of 10% on MRP.
2.6 Consultation fee as per CGHS rates for NABH Accredited hospitals.
2.7 Rates applicable for room rent (Accommodation Charges) for different categories of wards as given below:
General ward - Rs.1,000/- per day
Semi-private ward - Rs.2,000/- per day
Private ward - Rs.3,000/- per day
CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-
S. No. | Basic Pay (without the inclusion of grade pay) | Entitlement |
1. | Upto Rs. 13,950/- | General Ward |
2. | Between Rs.13,951/- and Rs.19,530/- | Semi-Private Ward |
3. | Rs.19,540/- and above | Private Ward |
2.8 Investigation rates and procedure charges for Chemotherapy shall be as per CGHS prescribed rates of concerned city.
2.9 Chemotherapy medicines shall be procured from CGHS wherever feasible and as per available brand. In case, medicines are supplied by hospital, they shall provide the same on credit to pensioners and shall offer a discount of 10% on MRP.
3. Cost of Implants / stents / grafts is reimbursable in addition to package rates as per CGHS ceiling rates for Implants / stents / grafts or as per actual, in case there is no CGHS prescribed ceiling rates.
4. The hospitals empanelled under CGHS shall not charge more than the approved CGHS rates.
5. No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the consequences of surgical procedure or due to any improper procedure and is not justified.
6. It has now been decided that the CGHS beneficiaries taking treatment in the empanelled hospitals will be entitled for reimbursement / treatment on credit as per the package rates / rates. The package rates are for semi-private ward. If the beneficiary is entitled for general ward there will be a decrease of 10% in the rates; for private ward entitlement there will be an increase of 15%. However, the rates shall be same for investigation irrespective of entitlement, whether the patient is admitted or not and the test per se does not require admission to hospital.
7. A hospital empanelled under CGHS. whose normal rates for treatment procedure / test are lower than the CGHS prescribed rates shall charge as per the rates charged by them for that procedure /treatment from a non-CGHS beneficiary and will furnish a certificate to the effect that the rates charged from CGHS beneficiaries are not more than the rates charged by them from non-CGHS beneficiaries.
8.1 Private ward is defined as a hospital room where single patient is accommodated and which has an attached toilet (lavatory and bath). The room should have furnishings like wardrobe, dressing table, bed-side table, sofa set, carpet. etc. as well as a bed for attendant. The room has to be air-conditioned.
8.2 Semi Private ward is defined as a hospital room where two to three patients are accommodated and which has attached toilet facilities and necessary furnishings.
8.3 General ward is defined as halls that accommodate four to ten patients.
8.4 Normally treatment in higher category of accommodation than the entitled category is not permissible. However, in case of an emergency when the entitled category accommodation is not available, admission in the immediate higher category may be allowed till the entitled category accommodation becomes available. However, if a particular hospital does not have the ward as per entitlement of beneficiary, then the hospital can only bill as per entitlement of the beneficiary even though the treatment was given in higher type of ward.
9.1 In case of non-emergencies, the beneficiary shall have the option of availing specific treatment / investigation from any of the empanelled hospitals of his / her choice (provided the hospital is empanelled for that treatment procedure / test), after the same has been advised by CGHS / other Government Specialist / CMO in-charge and permission is obtained from the competent authority.
10 Permission for treatment, is granted by CMO in-charge / Additional Director / Joint Director, CGHS in case of pensioners, former Governors, former Vice-Presidents, ex-MPs, Freedom Fighters. etc., and by Rajya Sabha / Lok Sabha Secretariat as the case may be in case of sitting Members of Parliament, concerned Ministry / Department / Organisation in case of serving Government employees, serving employees and pensioners of autonomous bodies covered under CGHS.
11 The empanelled hospitals shall honour permission letter issued by competent authority and provide treatment /investigation facilities as specified in the permission letter.
12 Hospitals shall provide credit facility to the following categories of CGHS beneficiaries (including dependant family members, whose names are entered on CGHS Card) on production of valid permission letter:Members of Parliament
Pensioners of Central Government drawing pension from central estimates
Former Vice-presidents, Former Governors and former Prime Ministers
Ex-Members of Parliament
Freedom Fighters
Serving CGHS employees
Serving employees of Ministry of Health & Family Welfare (including attached/
Subordinate offices under the Ministry of Health & Family Welfare) and
Such other categories of CGHS cardholders as notified by the Government.
12.1 Bills should be submitted to the Office of the Rajya Sabha Secretariat / Lok Sabha Secretariat in case of sitting Members of Parliament and to Additional Director, CGHS, Hyderabad through UTI —TSL in respect of Pensioners of Central Government drawing pension from central estimates; former Vice-presidents, Former Governors and former Prime Ministers; Ex-Members of Parliament; Freedom Fighters.
12.2 The hospitals shall extend credit facility to the above categories of CGHS beneficiaries under emergency / with prior permission irrespective of the CGHS city where they are registered and send the bill to Additional Director, CGHS, Hyderabad.
12.3 Bills of serving employees of the Ministry of Health & Family Welfare and the employees if attached / subordinate offices under the Ministry of Health & Family Welfare will be sent directly to the office / officer which / who referred the patients to the hospitals.
12.4 In case of emergencies empanelled hospitals shall not refuse admission nor demand payment from CGHS beneficiaries on production of valid CGHS card, issued by competent authority of any CGHS City.
12.5 Reimbursement in case of pensioners, former Governors, former Vice- Presidents, ex-MPs Freedom Fighters , etc., is made by CGHS and by Rajya Sabha Secretariat / Lok Sabha Secretariat in case of sitting Members of Parliament and by concerned Ministry / Department Organisation in case of serving Govt. employees, serving employees and pensioners of autonomous bodies covered under CGHS.
12.6 Serving Central Government employees and their dependent family members not covered by the CGHS will not be denied treatment at package rates if they approach the hospitals with a proper referral letter from the Ministry / Department in which they are working, after verifying the genuineness of the employee by production of his / her valid identify card issued by the appropriate authority.
12.7 Serving Central Government employees and their dependent family members not covered by the CGHS will not be denied treatment at package rates if they approach the hospitals in emergency condition to the patient. The treatment will given after verifying the genuineness of the employee by production of his / her valid identify card issued by the appropriate authority.
13 During In-patient treatment of the CGHS beneficiary, the hospital will not ask the beneficiary or his / her attendant to purchase separately the medicines / sundries / equipment or accessories from outside and will provide the treatment within the package rate, fixed by the CGHS which includes the cost of all the items.
14 If one or more minor procedures form part of a major treatment procedure, then package charges would be permissible for major procedure and only at 50% of charges for minor procedure.
15 Any legal liability arising out of such services, responsibility solely rests on the hospital and shall be dealt with by the concerned empanelled hospital themselves.
N.B. The exclusive cancer hospitals / Cancer units, which have only applied for NABH accreditation, would be considered for empanelment under CGHS provisionally and a 15% deduction would be applicable to the rates prescribed for cancer hospitals, However, such hospitals would be de-panelled without any further notice, if they fail to obtain NABH Accreditation within 180 days of empanelment, A copy of this Office Memorandum along with a copy of MOA are placed on internet at http://mohfw.nic.in/cqhsnew/
sd/-
(R.Ravi)
Director
ANNEXURE
S.No. | Name and address of the Exclusive Cancer / Whether NASH Hospital/ | Whether NABH Accredited |
1. | Omega Hospitals, MLA Colony Main Road, No.12, Banjara Hills, Hyderabad -34 (AP) Tel 040-2351034 | No |
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